Or. Admin. Code § 851-055-0080 - Office- Based Procedure Care Standards for Nurse Practitioners and Clinical Nurse Specialists

These rules are applicable when:

(1) Any procedure is performed in an office-based setting where the utilization of analgesic or anesthetic agents is used to mitigate client discomfort and/or pain associated with the procedure.

(2) Any procedure requiring deep sedation or analgesia, general anesthesia or regional blocks will require an Oregon licensed independent provider of anesthesia services (CRNA or Anesthesiologist) to administer anesthesia medications, and provide maintenance of the airway, breathing and circulation for the client.

(3) Informed consent utilizing the Procedures, Alternatives, Risks and Questions (PARQ) process must be obtained for any procedure where there is a risk to the client and should be separate from a general consent to treat. Consent must be obtained by the provider performing the procedure. A standardized form must be presented to the client for the following:

(a) To explain in general terms, the procedure or treatment to be undertaken;

(b) To inform the client of the possibility of alternative procedures; and

(c) To identify any potential risk of the procedure.

(4) Substantial details of the procedure or treatment must be disclosed to the client who requests more explanation, including the viable alternatives and the material risks unless to do so would be materially detrimental. To determine that further explanation would be materially detrimental, due consideration to the standards of practice of reasonable practitioners in the same or similar community under the same or similar circumstances must be identified.

(5) The procedure must be performed in compliance with these rules and must be within the APRN scope of practice for which educational preparation and competency have been established and maintained.

(6) The standard of care established by a professional organization for a procedure must be met. If a national nursing standard has not been established for a procedure, existing standards for healthcare providers performing the same procedure must be met.

(7) The American Society of Anesthesiologists (ASA) Physical Status Classification system will be performed and documented for each client undergoing a procedure requiring moderate sedation. The APRN performing the procedure must be responsible for the establishment of the client's ASA classification. Documentation must reflect the assessment and conclusion supporting the ASA classification.

(8) A client classified as ASA 4 are prohibited from receiving moderate sedation.

(9) Requirements for the complexity of the procedure:

(a) Level 1: Minor procedure performed without anesthesia or under topical, local or minor conduction block anesthesia not involving drug induced alteration of consciousness, other than minimal sedation utilizing oral anxiolytics. Active Basic Life Support (BLS) certification must be maintained.

(b) Level 2: Minor procedure performed under moderate sedation utilizing oral, parenteral, or intravenous sedation or other analgesic or dissociative drugs. The performance of these procedures requires the APRN to maintain the following:

(A) Advanced life support certification in population foci.

(B) Continuing education hours to assure the knowledge, skills, abilities, and judgements relevant to the procedure. These hours must be specific to the procedure and not included in specialty certification continuing education, unless these continuing education hours are accepted for by the professional certification body. In addition, continuing education include the use of medications used to induce moderate sedation, emergency interventions related to the client's unintended response to moderate sedation. The Board may request documentation of these hours for auditing purposes or any other Board authorized function.

(C) Constant attendance during the procedure and other competent office staff monitoring the following:

(i) Visualization of the client throughout the procedure.

(ii) Continuous physiological monitoring as deemed appropriate by the level of sedation and recording, at a minimum, heart rate, blood pressure, respiration, and oxygen saturation.

(iii) No other tasks other than those associated with the procedure.

(D) An emergency response plan must be established for a client undergoing a procedure defined by this rule to assure the client will receive appropriate care by personnel qualified to provide life sustaining interventions.

Notes

Or. Admin. Code § 851-055-0080

BN 13-2021, adopt filed 06/24/2021, effective 7/1/2021

Statutory/Other Authority: ORS 678.150, ORS 678.255, ORS 678.265, ORS 678.275, ORS 678.278, ORS 678.282, ORS 678.285, ORS 678.370, ORS 678.372, ORS 678.375, ORS 678.380 & ORS 678.390

Statutes/Other Implemented: ORS 678.150, ORS 678.255, ORS 678.265, ORS 678.275, ORS 678.278, ORS 678.282, ORS 678.285, ORS 678.370, ORS 678.372, ORS 678.375, ORS 678.380 & ORS 678.390